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[IP] Late Morning Highs and Mistaking Lows for Highs

After about 4 months of pumping, I'm still not really sure how well I am doing -
some days, I think I'm doing great, and other days, I'm ready to give up.

I've given this situation alot of thought, and may have found a reason for my
frustration. I think that my CDE has done a reasonably good job at setting my
basal rates and carb ratios. However, I don't think that he has educated me at
all. He makes the changes to the pump settings without explaining the reasoning
behind the changes. This may be fine in the beginning, but I think I should be
making these changes by myself, or at least in conjunction with my CDE and
internist. (I currently don't have an endo. Can anyone recommend a good endo in
the Philadelphia area with alot of pumping experience? Any suggestions on CDEs?)
I don't want to be totally dependent on my CDE forever!

After this long introduction, I have a question that maybe someone out there can
help me with. I typically eat breakfast at 5:30am. My breakfast is the same
every day - 5 pieces of white toast and 10 oz of orange juice. My glucose is
relatively constant and in range from about 5:15am until about 8:30am. If I
understand things correctly, this would indicate that my carb count and carb
ratio for breakfast are both set correctly. However, from 8:30am until 11:00am,
my glucose increases by about 100 or 150 points. I'm relatively confident that
my basal rates are correct during this time period. Bolusing brings it down
slowly, but it is normally about 5:00pm before I'm back in range.  I don't know
what changes to make to bring my numbers after 8:30am back in line. If I change
the carb ratio for breakfast, I'm concerned about going low at 8:30. I've used
temporary basal increases for other situations before (I'm on the Disetronic
pump), but again, the increase and time period for those situations (such as
pizza or fast foods) were set by the CDE - I don't know how to determine the
increase or time period by myself. Is a temporary basal increase, starting
either at breakfast or at some later time a good idea to bring my late morning
glucose back in range? Is there something else to try? Could it be a "glycemic
index" type problem? Any suggestions would certainly be appreciated!

On another topic - There has been alot of discussion lately about hypo
unawareness. Has anyone ever experienced what they thought was a low, only to
test and discover that they were high? This happens to me about twice a week.
Any ideas about what would cause this?

Thanks for any and all suggestions on these topics!

It's a bit early, but Happy Thanksgiving to everyone - it should be an
interesting one for me - first on one the pump!

== Steve ==

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